Link between OSA and the "beer gut"

split_city wrote:oh ok...it's hard to tell since I just began posting

Yup yup, no worries. I had to get broken in as well. Just trying to save you some typing.

Wulfman wrote:

split_city wrote:I can only study so much in 3 years!!

I have one other question (at the moment)......
Where are you going to find your "subjects" to study.....bars, taverns and saloons?

In reality, it's sort of a serious question. There have been "studies" claiming that only about 50% of the CPAP patients are compliant with their therapy. In a discussion on the forum last year, we were of the opinion that CPAP users who were more involved with their therapy (monitoring with machines that recorded nightly statistics and using the software to interpret it) were far more compliant than the patients who were given the cheapest machines and masks by their doctors.....and who didn't have a clue how their therapy was working. BUT.....how would one do a study to prove it?
In order to do a study, you'd have to have access to patient information and that sort of thing is (supposedly) protected by the doctor-patient privileges.

Just wondering.....

Den

NightHawkeye wrote:

split_city wrote:Hi all. This is my first post in this forum. I'm currently a PhD student working in the area of sleep apnoea. I have been looking at one potential mechanism which might explain why sleep apnoea is predominant in males.

Hi Daniel,

Thanks for the thought provoking theory. Not being obese myself, I'm not sure I fit your pattern theory, but I will tell you that my OSA is definitely related to GERD. Have you studied that association yet?

Also, out of curiosity, is this theory directly related to your dissertation, and what is your major field of study? (MD's don't study this stuff.)

Regards,
Bill

Yep, there are many people who have OSA who aren't obese or overweight for that matter. Potential causes relate to upper airway anatomy, cranio-facial abnormalities and ventilatory instability. I personally haven't studied the link between GERD and OSA. Just doing a quick search, I came across this review

"The relationship between extraesophageal reflux (EER) and obstructive sleep apnea (OSA). Sleep Med Rev. 2005 Dec;9(6):453-8. Epub 2005 Sep
22.

and this abstract:

Gastroesophageal reflux and laryngopharyngeal reflux in patients with sleep-disordered breathing.Wise SK, Wise JC, DelGaudio JM.
Department of Otolaryngology-Head and Neck Surgery, The Emory Clinic, 1365A Clifton Road NE, Atlanta, GA 30322, USA.

OBJECTIVE: To assess the relationship of gastroesophageal reflux (GER) and laryngopharyngeal reflux (LPR) with obstructive sleep apnea (OSA). PATIENTS AND METHODS: Thirty-seven sleep-disordered breathing (SDB) patients underwent polysomnography (PSG) and dual-channel pH probe testing. LPR was defined as greater than 6.9 proximal reflux episodes or reflux area index (RAI) greater than 6.3. GER was defined as greater than 4% of time below pH 4.0. RESULTS: OSA was present in 28 patients. Twenty-three patients had LPR (66.7% of snorers, 60.7% of OSA patients). Twenty-one patients had GER (33.3% of snorers, 64.3% of OSA patients). Body mass index (BMI) correlated positively with respiratory disturbance index (RDI) (r = 0.67, P < 0.001). BMI did not correlate with pH probe parameters. OSA presence/severity did not correlate with LPR or GER. Supine LPR and GER events did not correlate with OSA presence/severity. CONCLUSION: Gastric acid reflux is prevalent in SDB patients. Direct correlations between reflux and PSG parameters were not identified.

I would have predicted that GERD would generally be related to obesity. Obesity is a common feature in OSA patients. However, this abstract found no association between BMI and pH probe parameters. I don't know how this would affect healthy-weight individuals

[quote="Morpheus"]I get the impression that obesity is highly correlated to apnea. (See below, for example.) But I also thought about 30 percent of OSA patients are of normal weight. I'm a 5'10" male and weigh 165, work out with weights and run regularly, don't smoke, have no faciocranial abnormalities or enlarged tonsils. But I have had (treated) moderate apnea for about seven years. No one in my family has it - though I do have a marathon runner friend who has it, as do many of his family members.

Department of Otorhinolaryngology, Head and Neck Surgery, Hacettepe University Faculty of Medicine, 06100 Hacettepe, Ankara, Turkey.

OBJECTIVE: To investigate body fat composition, measured by bioelectrical impedance assay (BIA), for predicting the presence and severity of obstructive sleep apnea-hypopnea syndrome (OSAHS). Body fat composition was also compared with other well-known OSAHS predictors such as body mass index (BMI), neck circumference, and abdominal visceral fat. STUDY DESIGN: A prospective study was designed. Fifty-one patients (41 male, 10 female), who were referred to Hacettepe University Faculty of Medicine, Department of Otorhinolaryngology, Head and Neck Surgery with suspected OSAHS, between April 2003 and June 2004, were included in the study. METHODS: All patients underwent polysomnography (PSG) and were classified according to their apnea-hypopnea index (AHI) into four groups. The cross-sectional area of abdominal visceral fat was measured by computed tomography (CT) scanning in 33 of the patients. Neck circumference and BMI was measured for all patients. BIA was performed to determine body fat composition. The groups were compared, and correlation of the variables with AHI was investigated. RESULTS: Of the variables, BMI and percentage of body fat (determined by BIA) were found to be significantly correlated with AHI (r = 0.782, r = 0.647). CT of cross-sectional area of abdominal visceral fat provided 100% sensitivity and specificity (P < .001) in differentiating simple snorers from OSAHS patients. By combining percentage of body fat and body fat mass, higher levels of sensitivity (95%) and specificity (100%) were achieved for diagnosis of OSAHS. CONCLUSION: It was concluded that the BIA could be an inexpensive and practical alternative to prePSG screening tests and should be included in the evaluation of OSAHS patients.

Laryngoscope. 2005 Aug;115():1493-8.

RosemaryB wrote:
Having done doctoral level research myself, I can appreciate the need to narrow one's topic! However, narrowing one's topic in a way that perpetuates confirmation bias results in flawed research.

If you wish to study a link between OSA and hip/waist measurement, including both genders (or even studying women) would make a significant contribution and would strengthen your research. If I were on your committee, this is certainly one thing I would want to explore with you. Including gender would make a more sophisticated contribution to the field, and probably a more original one.

Rosemary, Daniel already gave some good reasons, but I just had to add this: He is working on a PhD under an advisor. (Yes, there is a committee to whom he answers, but they don't generally have as much input as the primary adviser.)

Maybe these things are not true for his program and university, but IMHO, and IMH experience, the adviser approves or denies the topic and each section of the dissertation. The true researcher doesn't really get to do anything on his or her own until AFTER the doctorate is actually earned. Go to the hallways of any university and talk to doctoral students. The stories will not only be entertaining, but also full of frustration.

One that I recall was the adviser would not like a section and want it done differently. The next time, the alternate way was not acceptable and the student had to use the first way--presented as if it had never been done. This happened with a few more flip-flops between the versions/methods, and became a private joke to see how many times each version had been used!

Thus, poor Daniel absolutely must do whatever he can to be graduated with his doctorate--and has little power over the exact hypothesis at this point. It is already set and underway.

Hello split-city

Thanks for your post. I found your research and results to be very interesting and hope that you will continue to post on this forum now and then.

Are you aware of any studies of pregnant women and sleep apnea? They undergo a large increase/decrease in abdominal size over the course of pregnancy and giving birth. Do they develop sleep-disordered breathing corresponding to increasing abdominal size?

Also any thoughts on why some people exhibit a significant increase in AHI during REM and some don’t. What could be different between those two groups?

It is my understanding that BMI is associated with the severity of OSA, but not with the presence or absence of it. IOW, if you have mild apnea and gain weight, it will increase the severity of the disease. But if you have the disease and lose weight, the disease won't go away.

Any evidence to the contrary? I'm fairly new to all of this.

split_city wrote:

Snoredog wrote:

split_city wrote:
The problem with these types of forums is that I'm sure many unhappy OSA patients who have undergone unsuccessful surgical procedures would want to let off their "steam" via this type of medium. I'm sure it would be biased towards them compared to patients who have been successfully treated.

Problems??

boy for a doctor you are as dumb as rock aren't ya? FYI: These forums got started because not because we were obese or "surgery rejects" but because we were patients seeking common sense answers to questions we were NOT getting or couldn't get from our doctors. You may know them, the ones with the same philosophy as yours wearing the same white coat.

I would say the people that regularly visit here are not from any phat farm but have white coat syndrome. But instead of it being hypertension it was where the BS factor skyrockets. So they ended up here to help each other because the allotted 2-5 minutes by their doctor for answers just wasn't quite long enough.

People that come here already know they have OSA and probably know more about it than you ever will. Most that visit here can easily smoke any sleep doctor I know when it comes to knowledge about their disorder and/or therapy. Telling them the risk factors over and over isn't going to change that fact any.

If you really want to help patients with OSA, go find a solution to preventing the tongue from falling into the back of the throat, or stop their legs from kicking during sleep or find the reason they don't sleep uninterrupted throughout the night from spontaneous arousals because we have enough sleep doctors with the same ole stereotypes. But the first place to start would be with listening, most doctors are not very good at that so you are not alone.

Say you weren't that white coat in front of me at Costco in a beat up toyota corolla pumping his own gas were ya?

Wow, it seems someone is getting pretty defensive here. Calling me a dumb doctor is really mature now isn't it?

By the way i am NOT a physician! I am working in research. I do NOT run clinics to see patients. While it seems there are problems with doctors world wide, I know that this is not always the case. These forums are great but obviously there will be many unhappy people out there who have undergone surgery or lost weight and their OSA didn't go with it. As I keep repeating, there is no number one cause of OSA.

You call me dumb yet you are naive enough to think that collapse is ONLY caused by the tongue flopping backwards. How wrong you really are. How do you know my background about OSA? Are you one of these people who think you know more about the disease than me? Obviously you don't given the fact you think OSA only has one cause. This white coat stuff is quite funny. I'm not a crazy scientist. I'm out there trying to help the OSA community because as you said, not all people get rid of their OSA following surgery. You do realise that OSA patients do have tongue reduction surgery? This doesn't always help now does it. There are studies out there looking at all the things you described. These studies take time (and lots of money)

Oh and I do listen to the patients I recruit for that matter.

What is your hidden agenda?

I thought I was pretty clear, you ARE dumb as a rock if you think everyone that comes to these forums are obsese or surgery rejects, if that is the case I STAND by my previous statement 100%.

[quote="GuestForADay"]Hello split-city

Thanks for your post. I found your research and results to be very interesting and hope that you will continue to post on this forum now and then.

Are you aware of any studies of pregnant women and sleep apnea? They undergo a large increase/decrease in abdominal size over the course of pregnancy and giving birth. Do they develop sleep-disordered breathing corresponding to increasing abdominal size?

Also any thoughts on why some people exhibit a significant increase in AHI during REM and some don’t. What could be different between those two groups?

2) These hormones are known to protect the airway against the collapse. Therefore, we believed that the compressive effects of this abdominal cuff may have had little influence on upper airway collapsibility

For me there is no beer gut, no obesity, no 'fat neck', nor any protection provided by my hormones.

I hope all possible causes are eventually covered by research. Please let us know what you find, Daniel.

Snoredog wrote:

split_city wrote:

Snoredog wrote:

split_city wrote:
The problem with these types of forums is that I'm sure many unhappy OSA patients who have undergone unsuccessful surgical procedures would want to let off their "steam" via this type of medium. I'm sure it would be biased towards them compared to patients who have been successfully treated.

Problems??

boy for a doctor you are as dumb as rock aren't ya? FYI: These forums got started because not because we were obese or "surgery rejects" but because we were patients seeking common sense answers to questions we were NOT getting or couldn't get from our doctors. You may know them, the ones with the same philosophy as yours wearing the same white coat.

I would say the people that regularly visit here are not from any phat farm but have white coat syndrome. But instead of it being hypertension it was where the BS factor skyrockets. So they ended up here to help each other because the allotted 2-5 minutes by their doctor for answers just wasn't quite long enough.

People that come here already know they have OSA and probably know more about it than you ever will. Most that visit here can easily smoke any sleep doctor I know when it comes to knowledge about their disorder and/or therapy. Telling them the risk factors over and over isn't going to change that fact any.

If you really want to help patients with OSA, go find a solution to preventing the tongue from falling into the back of the throat, or stop their legs from kicking during sleep or find the reason they don't sleep uninterrupted throughout the night from spontaneous arousals because we have enough sleep doctors with the same ole stereotypes. But the first place to start would be with listening, most doctors are not very good at that so you are not alone.

Say you weren't that white coat in front of me at Costco in a beat up toyota corolla pumping his own gas were ya?

Wow, it seems someone is getting pretty defensive here. Calling me a dumb doctor is really mature now isn't it?

By the way i am NOT a physician! I am working in research. I do NOT run clinics to see patients. While it seems there are problems with doctors world wide, I know that this is not always the case. These forums are great but obviously there will be many unhappy people out there who have undergone surgery or lost weight and their OSA didn't go with it. As I keep repeating, there is no number one cause of OSA.

You call me dumb yet you are naive enough to think that collapse is ONLY caused by the tongue flopping backwards. How wrong you really are. How do you know my background about OSA? Are you one of these people who think you know more about the disease than me? Obviously you don't given the fact you think OSA only has one cause. This white coat stuff is quite funny. I'm not a crazy scientist. I'm out there trying to help the OSA community because as you said, not all people get rid of their OSA following surgery. You do realise that OSA patients do have tongue reduction surgery? This doesn't always help now does it. There are studies out there looking at all the things you described. These studies take time (and lots of money)

Oh and I do listen to the patients I recruit for that matter.

What is your hidden agenda?

I thought I was pretty clear, you ARE dumb as a rock if you think everyone that comes to these forums are obsese or surgery rejects, if that is the case I STAND by my previous statement 100%.

Read my post again. Did I say all of these people or many unhappy people??

Edit: However, it was a bad choice of words to say "the problem with sites like these..." I apologise for that because forums do provide the opportunity for people with OSA to chat with one another.

split_city,

Do you have any statistics on how many people have sleep apnea? Since I was diagnosed 16 months ago, I have come to the point of thinking 40% of the world's population will eventually develop sleep apnea. I also believe the next big leap in average life expectancy will come when an easy, cheap and widely distributed cure (or treatment) is found.

BTW, I am one of the many slim and physically active people who have severe osa.

rooster

rooster wrote:split_city,

Do you have any statistics on how many people have sleep apnea? Since I was diagnosed 16 months ago, I have come to the point of thinking 40% of the world's population will eventually develop sleep apnea. I also believe the next big leap in average life expectancy will come when an easy, cheap and widely distributed cure (or treatment) is found.

BTW, I am one of the many slim and physically active people who have severe osa.

rooster

I don't have any papers with me at the moment but a famous paper back in 1993 showed that as many as 4% of midde-aged males and 2% of middle aged females had OSA. This has probably risen since then. This percentage goes up with increasing BMI. I recall a paper showing that about 50% of morbidly obese people had OSA. Furthermore, there is controversy in terms of the male:female ratio. It can be anywhere from about 2:1 up to 10:1 depending on the study.

Unfortunately, there aren't any quick fix cures. CPAP is the primary form of treatment but "generally" weight loss (in overweight/obese sufferes) is the key. Surgery is another approach but it doesn't always work. Lots more research needs to be conducted

Bamalady wrote:

2) These hormones are known to protect the airway against the collapse. Therefore, we believed that the compressive effects of this abdominal cuff may have had little influence on upper airway collapsibility

For me there is no beer gut, no obesity, no 'fat neck', nor any protection provided by my hormones.

I hope all possible causes are eventually covered by research. Please let us know what you find, Daniel.

Thanks. I'll keep you posted

birdshell wrote:

RosemaryB wrote:
Having done doctoral level research myself, I can appreciate the need to narrow one's topic! However, narrowing one's topic in a way that perpetuates confirmation bias results in flawed research.

If you wish to study a link between OSA and hip/waist measurement, including both genders (or even studying women) would make a significant contribution and would strengthen your research. If I were on your committee, this is certainly one thing I would want to explore with you. Including gender would make a more sophisticated contribution to the field, and probably a more original one.

Rosemary, Daniel already gave some good reasons, but I just had to add this: He is working on a PhD under an advisor. (Yes, there is a committee to whom he answers, but they don't generally have as much input as the primary adviser.)

Maybe these things are not true for his program and university, but IMHO, and IMH experience, the adviser approves or denies the topic and each section of the dissertation. The true researcher doesn't really get to do anything on his or her own until AFTER the doctorate is actually earned. Go to the hallways of any university and talk to doctoral students. The stories will not only be entertaining, but also full of frustration.

One that I recall was the adviser would not like a section and want it done differently. The next time, the alternate way was not acceptable and the student had to use the first way--presented as if it had never been done. This happened with a few more flip-flops between the versions/methods, and became a private joke to see how many times each version had been used!

Thus, poor Daniel absolutely must do whatever he can to be graduated with his doctorate--and has little power over the exact hypothesis at this point. It is already set and underway.